All middle-aged adults should be screened for hepatitis C, panel says

Adults born between 1945 and 1965 should be screened once for hepatitis C, a government-backed panel recommended today.

The statement, from the U.S. Preventive Services Task Force (USPSTF), is stronger than draft recommendations published in November, which advised doctors to "consider offering screening" to members of the Baby Boom generation (see Reuters Health story of Nov 26, 2012 here: reut.rs/WsjtVA).

The final recommendations - which also call for screening people at high risk of hepatitis C, such as injection drug users - were published Monday in the Annals of Internal Medicine.

The "moderate" net benefit of screening was supported by studies showing people with the chronic infection who take medicine and have a very low level of the virus in their blood - known as a sustained viral response - are at lower risk of liver cirrhosis, cancer and death.

"New evidence came out since the draft recommendation, which gave us greater confidence in the linkage between a sustained viral response and important outcomes," Dr. Albert Siu, co-vice chair of the task force, said.

The USPSTF also found that tools used to assess liver health and guide treatment are becoming safer, and that the harms of hepatitis C medication, including headaches and flu-like symptoms, are "small."

Hepatitis C is treated with a combination regimen of ribavirin and peginterferon alfa (also commonly known as Pegasys and Peg-Intron), to which newer drugs - known as boceprevir (Victrelis) and telaprevir (Incivek) - can be added.

Siu, from the Icahn School of Medicine at Mount Sinai in New York, said the rate of hepatitis C among people born in 1945 through 1965 is about 4 percent, compared to about 1 percent among other Americans.

That difference is likely due to "risky behavior that was engaged in during this time," he said.

Many people living with hepatitis C are not aware they have the condition, the task force said, and may go years without showing symptoms.

Stanford University's Jeremy Goldhaber-Fiebert, who worked on one of the studies that influenced the updated recommendation, said that screening middle-aged adults seems to be effective and cost-effective - but that there are other considerations as well.

"It's really important that when screening is rolled out, that we ensure that those people who screen positive have access to timely, high-quality treatment," he said.